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When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics

Authors Seelig J, Pisters R, Hemels ME, Huisman MV, ten Cate H, Alings M

Received 28 June 2019

Accepted for publication 28 August 2019

Published 17 September 2019 Volume 2019:15 Pages 399—408

DOI https://doi.org/10.2147/VHRM.S187656

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Professor Magnus Bäck


Jaap Seelig,1 Ron Pisters,1 Martin E Hemels,1,2 Menno V Huisman,3 Hugo ten Cate,4,5 Marco Alings6

1Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands; 2Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands; 3Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; 5Anticoagulation Clinic Maastricht, Maastricht, The Netherlands; 6Department of Cardiology, Amphia Hospital, Breda, The Netherlands

Correspondence: Martin E Hemels
Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, Arnhem, AD 6815, The Netherlands
Tel +31 64 126 8279
Email mhemels@rijnstate.nl

Abstract: Stroke prevention with oral anticoagulants in patients with atrial fibrillation predisposes for bleeding. As a result, in select patient groups anticoagulation is withheld because of a perceived unfavorable risk-benefit ratio. Reasons for withholding anticoagulation can vary greatly between clinicians, often leading to discussion in daily clinical practice on the best approach. To guide clinical decision-making, we have reviewed available evidence on the most frequently reported reasons for withholding anticoagulation: previous bleeding, frailty and age, and an overall high bleeding risk.

Keywords: hemorrhage, frail elderly, age, anticoagulants, atrial fibrillation

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